Laserfiche WebLink
6) <br /> ORIGINAL STATE OF CALIFORNIA DO not fill an <br /> THE RESOURCES AGENCY p� <br /> e with DWR DEPARTMENT of WATER RESOURCES NO. 071032 <br /> of Intent No. WATER WELL DRMLERS REkORT State Well No <br /> 5 Fermat No or Dat Other Well ho� �� 0 <br /> (1) OWNER. am (12) WELL LOG Total dcvdzI r - �� Depth of completed well ft <br /> Addie from ft to ft F tion (Describe by color, character, size or material) <br /> City p — <br /> ( Al F WELC.. ('See instructions) <br /> Conn Oxrner'a Wnll Number f NqL <br /> Well addrtss if dr rent from bov � t / <br /> ToSvmhinnnge t .�7 „; ._met do <br /> Distance from cities,roads,railroads,fences,etc <br /> CL (3) TYPE O ORR- <br /> p New WoOd Deepening 0 <br /> Reconstruction ❑ <br /> Reconditioning 0 <br /> XQ Horizontal Well ❑ <br /> Destruction ❑ (Describe <br /> O1LY destruction matorials — <br /> procedures ra Item <br /> (4) PROPOSED <br /> mostic <br /> Duer rr tion <br /> Industrial ❑ <br /> t Woll ❑ — <br /> st -- <br /> Mumci ' <br /> WELL LOCATION SMTCH Other ❑ — <br /> (S) EQUIPME (6) GAA AMC 12 <br /> Rotary Reverse ❑ No Six <br /> Cable ❑ Air p r of bore <br /> Other ❑ bucket ❑ � m y <br /> (7) CASING INSTALLED (B) ERFORA 52 <br /> Steel❑ Plastic c t Type of c a bize of scree From To Dia. g r F a To <br /> ft f 1n Wall ft s — <br /> dQ — <br /> (9) WELL SEALr <br /> Was svrfaco aanihsry seal provided? Yoe Na 0 yes, M depel—l�Ft <br /> Were strata sented against po on? Y B��/ ❑ Inten+nh ft <br /> Method of sealin Work atarte 9 Complet 14YCZ <br /> (10) WATER LEVELS: WELL DRISTATEMENT <br /> Depth of tint water, if knov,m R Chfs well taw' dr under i1 itn' ( �adtl"�arrWoofhe hest of mu <br /> Standing level after well completion ft kPowtedse an f <br /> (11) WELL TESTS. SIG.11TL <br /> Was wail test made? Yes ❑ No yes, by whom? t (Well Driller) <br /> type of test Pump ❑ Bailer C) Arr lift o NAM - L 1'` ti0gcompanip <br /> Depth to water at start of tear ,ft At end of test_ ft ¢i firm,or Cq"080tft(jr0r printed) <br /> rga �gal/min after 'hours Water tempera Address <br /> fd analysis made? Yes (:INo Wt+ yes,u by whom? Ctty <br /> s 711. <br /> electrlo log m rde? Yes © No .tach copy to this report License No. C�2 2 oZ D1to of this report <br /> DWA tae (as:v 7 75) IF ADDITIONAL SPACE 15 NEEDED. USE NEXT CONSECUTIVELY NUMBERED FORM <br />